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HomeMy WebLinkAboutBuilding Permit #765 - 412 MASSACHUSETTS AVENUE 5/21/2007Permit NO: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family 4 I El Addition El Two or more family 11 Industrial 11 Alteration No. of units: 0 Commercial X Repair epIa—ce-m--enT--_) E Assessory Bldg 11 Others: El Demo itio—n--, Ll Other o eptpo� nWell dp 1 Distnaty DESCRIPTION OF WORK TO BE PREFORMED: entification Please Type or Print Clearly) OWNER: Name: NC'CPhon Address: W Mase Ari. 1--Rsz" t6NTRAc TOW Na e� 'A' one 4 I ,Address.. �i- A, Via isbr' ConstrmtO License, "Supie- Dome lm r©cement License: 01> E km' ate,, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ 1 0— ---- Check No.: I � I II Receipt No.: 420 )— -e 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund A contractor Signature of Agerilipwri r:-:!":� .,Signature 6 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL no ix Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIltE-DEPARTMENT Temp Dumpsterdmsite 'ye Y Y no ix 'at""" Locatd d 1 Street 24 Main Fire Departmentignatureldate . .. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract Li Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks L3 Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) u Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract u Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location •m��-- No. Date -� NORTh TOWN OF NORTH ANDOVER Of "O '•,�O 9 Certificate of Occupancy $ ` �� s'••° • t<� Building/Frame Permit Fee $ 77 — ^CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #_Q_r t�. 2 0 2 )V:�!�Building Inspector Thursday, May 17, 200710:47 AM Craig Smith 603594-5973 p.04 HOME IMPROVEMENT CONTRACT (, , Sold, Furnished and Installed by: s�° Date: s L � 1 Q� THD At-home Services, Inc. Branch Name: iii fi{ d/bla The Home Depot At -Home Services 345A Greenwood Street; Worcester, MA 01607 Branch Number: 2, -- Job#-.,2AjD7q771J Toll Free (800) 657-5182; Fax: 508-756-2859 Federal iD # 75-2698460 ME Lic # C 02439 RI Cont Lic# 16427 CT Lic # 565522; MA Home improvement Contractor Reg. til 26893 Installation Address: 4i;_ m4 C til �� tate Zip City Last 4 Digits of Driver's Purchaser(s): Lic. # & Ex . Mo/Yr: Work Phone: Howl dei Home Address: _CS Zip (If different from Installation Address) City E-mail Address (to receive updates and promotions from The Home Depot): Project information: I/We/You ("Purchaser'l, the owners of the property located at the above installation address, offer to contract with TND At-home Services, Inc. ("Home Depotn of all materials furnish, dheatmein by reference and for the made a part hereof. as described on the attached Spec Sheet It (.t� 3 �/q; '`(�___incorporated Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract NS CONTRACT AMOUNT �) SS 46:3(..D,) to yr. "b CCtLESS DEPOSIT $ I 0 BALANCE DUE ON COMPLETION $,3tf,yLc D tMinimum 250/ of Contract Amount due upon execution of this contract. Indicate Payment Method For BALANCE DUE ON COMPLETION: 4)�N CG *When you provide a check as payment, you authorize us either to I= information from your cluck to make a one-time electronic fund transfer from your account or to process the payment m a check transaction. When we use information from your check to make an electronic fund transfer, fiords may be withdrawn from your account as soon as the payment is received, and you will not receive your check back. DEPOSIT PAYMENT Vir — (Subject to fulndd vvveenfieation and/or credit approval.) 1. tree ,Cas leis Check nfUSstal Service Money Order e payable to Tho Home Depot). 2. Crc& Card" and/or other payment options - Circle One Below Visa MasterCard Discover American Express The Horne Depot Home I rovement Loan a Home Depot Credit 0 New Account xisting Account (HIL & ADCC ONLY) Available Credit: S 00 (IUL & UDCC ONLY) F63S-SA6A0q? &10Exp.Date: --� Name as it appears on card:y�-- ""By my/out signature below, i/We agree to allow Home Depot to charge the above referenced credit card for the deposit indicated. Cardho t/--- /�, -- s ignatttre [e HIL or HDCC Authorization Codes Deposit Final Payment # 0 .77:J Purchaser agrees that, immediately upon completion of the work, Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement, contaui the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both patties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day, but BEFORE materials are ordered. There will be a service charge equal to 25% of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MYIOUR SIGNATURE BELOW, IME UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND 1/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. By MYJOUR SIGNATUREACKNOWLEDGE RECEIPT OF BELOA COPY OF THIS T NBE B T AND TWOO CCOMP THE ETED COPIES OF THS OF THIS E NOTICE OF CANCELLATION. SUBMITTED BY: Date al 9?�4 6 ACCEPTED BY: Date: tn;ser Date: Purchaser NOTICE: ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT Ulhito_Rrnrrh Filr. Yellow -Customer Pink- Sales Consultant R AT-HOME Installed SERVICES Siding and Windows SM ✓',lam 6ma Board of Building Refpladons and Standards HOME IMPROVEMENT CONTRACTOR. THE Home Depot Vt BUNROEUN CHFI�N Y'#'S 3200 COBB GALLEFU AtIANTA, GA 30339 126893. `8/32008 Siip Iement Card ,l-} ,20 Administrator y Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor. 345 Greenwood St. Unit 2 • Worcester, MAO 1607 • 508-756-6686 • Fax 508-756-2859 • Toll Free 800-657-5182 , � MARSH CERT[FI:GATE 4FINSURANCE CERTIFICATE NUMBER � _ � � � � »� � .. h ATL-001234410-01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA, INC. N0 RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE homedepot.certrequest@marsh.com POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE FAX (212)948-0902 AFFORDED BY THE POLICIES DESCRIBED HEREIN. 3475 PIEDMONT ROAD, SUITE 1200 ATLANTA, GA 30305 COMPANIES AFFORDING COVERAGE COMPANY 100492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED COMPANY HOME DEPOT USA, INC. B ZURICH AMERICAN INSURANCE COMPANY 2455 PACES FERRY ROAD NW COMPANY BUILDING C-8 ATLANTA, GA 30339 C AMERICAN HOME ASSURANCE COMPANY COMPANY D NEW HAMPSHIRE INS COMPANY COVERAGES ; sTlirS celfitetlpersedes and replaces any preaAously issued certl$cate.:fortpe poilcy period noted. below:., 2 . THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS DATE (MMIDDIYY) DATE (MWDDIYY) A GENERAL LIABILITY IPR 3757 608-02 03/01/07 03/01/08 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS -COMP/OP AGG $ 4,000,000 * CLAIMS MADE a OCCUR 'OF SIR: $1,000,000 PER OCC' PERSONAL & ADV INJURY $ 4,000,000 EACH OCCURRENCE $ 4,000,000 OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one tire) $ 1,000,000 MED EXP (Any one person) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-04 03/01/07 03/01/08 X COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY I $ T NON-OWNED AUTOS (Per accident) X ELF-INSURED AUTO--- -- PROPERTY DAMAGE $ PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ — AGGREGATE $ A EXCESS LIABILITY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 X UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND 2921209 (CA) W S A U- 0TH- EMPLOYERS' LIABILITY 03/01/07 03/01/08 X TORY LIMITS ER E 2921210 (FL) 03/01/07 03/01/08 EL EACH ACCIDENT_ $ 1,000,000 F THE PROPRIETOR/ X INCL 2921211 (AZ, ID, MD, VA) 03/01/07 03/01/08 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVE D OFFICERS ARE: EXCL 2921208 (AOS) 03/01/07 03/01/08 EL DISEASE-EACH EMPLOYEE $ 1,000,000 C OTHER 2921213 (QSI) 03/01/07 03/01/08 E WORKERS'COMPENSATION 2921212 (KY, MO, NY, WI)- 03/01/07 03/01/08 G TEXAS EMPLOYERS TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY _LISIR 2,000,000 DESCRIPTION OF OPERATION S/LOCATIONSIVEHICLESISPECIAL ITEMS CERTIFICATE HOLDER -;. w CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE TYIEREOF. FOR EVIDENCE ONLY THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL _A. DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: MaryRadaszewski '`hP.1t'f ! � �F.r.a� •f-., - 'MM1(3IO2) VALID AS OF: 02!28107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 313licant Information n Name (Business/Organization/Individual): Address: :2-N ry-C- City/State/Zip:---a=r-6 .1�O3 - Phone #: - - 6? c�<j / g �2 ._. Are you an employer? Check the appropriate box: 1 I • am a employer with .d 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp, insurance workers' comp, insurance. 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing all officers have exercised their work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' *Any applicant that checks box of comp, insurance required.] t Ho l must also fill out the section below showing their workers' com Type of project (required): 6. EJ New construction 7. Remodeling 8. Q Demolition 9. Q Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.E] Other meownors who submit this affidavit indicating they are doing all work and then hire outside contractors must submit new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing. workers' compensation information. insurance for my employees , Below is the policy and job site Insurance Company Name: I" H,,� Co Policy # or Self -ins. Lic. #: A -1 02 rot 8' Expiration Date: 3/i/v Job Site Address: T City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern `j/�und/e/r�the pains and7newaldes of perjury that the information provided above is true and correct Oficial use only. Do not write in this area, to be completed by city or town official City or Town' Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• P Fo� O F=4 I W CL C � o w CD C • a W a a C. 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